648 MEDICAL D.D.T. is not absorbed by the skin, but, when dissolved in kerosene oil or any organic solvent, it is readily absorbed in this way, and produces poisonous symptoms. D.D.T. emulsions and oily solutions may be readily absorbed by the lungs on inhalation and cause poisoning. , , ; ; Symptoms.— Nausea, vomiting, coughing, excitability ,,r,vertig&> muscular tremors, convulsions, inco- ordination, tingling in the arms and legs, fparalys&B of nthe1 legs, pul- monary oedema, unconsciousness, coma or collapse and death from respiratory failure. Fatal Dose and Fatal Period.— It has been estimated that a lethal dose for man is between 150 and 600 mg. per kilogramme of body weight. About one-third of^an ounce of solid D.D.T., i.e. about half a gallon in solution would be fatal to an adult,4* A male- child,46 19 months old, died in four hours after swallowing about an ounce of a 5 per cent solution of D.D.T. in kerosene. A farm labourer,47 aged 32 years, died in less than an hour after he had taken 6 ounces of concentrated emulsion containing 34 g. of D.D.T. and 2.4 ounces of methyleychlohexanone. Treatment—Wash out the stomach and treat the symptoms. Inject atropine hypo- dermically. Administer calcium gluconate intravenously. If necessary, resort to arti- ficial respiration. Post-mortem Appearances.— The mucous membrane of the stomach and upper part of the small intestine is hyperaemic with submucous haemorrhages. The stomach usually gives off the smell of kerosene oil. The spleen and liver are congested. The lungs are congested and cedematous. The brain is congested. Chronic Poisoning. — This may occur from slow absorption of the oily emulsion by the skin and from the ingestion of small amounts of the material over a long period. • Symptoms.— These are loss of appetite, mental anxiety, insomnia, aching pain in the legs, , muscular weakness and tremors, anaemia, emaciation, convulsions, coma 'and death. There is also increased susceptibility to various infections. Treatment — Cathartics, fats or oils should not be given, as they promote absorption. Phenobarbital may be administered to control tremors and convulsions. Persons employed for dusting and spraying D.D.T. should use goggles for the eyes, and should wear respirators and protective clothing when there is a possibility of the oily emulsion contaminating the skin. Post-mortem Appearances. — The liver and the kidneys may show necrosis and degenerative changes. BROMOFORM (TRIBROMOMETHNE) , CHBr» This is a heavy, limpid, colourless, volatile, sweet liquid, which is soluble in\ chloroform and ether, but slightly soluble in water. It is a B.P.C, preparation and is ad- ministered to children in J to 2 minim, doses for whooping cough. Being slightly soluble in water and a heavy liquid, it has a tendency to settle down at the bottom and, if taken without shaking the bottle, it is apt to produce poisonous symptoms. Almost all the cases "of poisoning so far recorded have occurred among children, Symptoms.— These are very similar to those caused by swallowing chloroform ; the chief being vertigo, sleepiness, muscular relaxation, contracted pupils, insensibility, stertorous breathing, weak, feeble, irregular pulse, collapse and death. The vapour of bromoform also produces symptoms similar to those caused by chloroform inhalation. Fatal Dose. — Three or four minims of bromoform, each administered to two children, aged 2 and 4 years respectively, produced poisonous symptoms.48 Thirty-six minims of bromoform proved fatal to a girl, aged 5 years.*9 This drug was made up in a mixture with mucilage and water and dispensed in a bottle. It settled down to the bottom, hence the whole quantity was probably taken in the last dose from which she died. On the other hand, recovery has taken place after one drachm and a half swallowed by a girl of 6 years.50 JTatal Perioa.— Death occurred in 5 hours in the above-mentioned case. . ; Treatment^rW ash out the stomach with a solution of sodium carbonate or Condy's fluid. Use^Kypodermically stimulants, such as ether and strychnine. Apply electricity and start artificial respiration. Post-mortem Appearances. — Odour of bromoform in the organs. Congestion of the stomach and duodenum. 45. Pharm,. Jour-, Feb. 16, 1946,, p. 110. 46. Hill and Robinson, Brit. Med. Jour,, Dec. 15, 1945, p. 845. 47. Bidden-Steele and Stucfcey, Lancet, Aug. 17, 1946, p 235 48. Stokes, Brit. Med. Jour., May 25, 1900, p. 1283 49. Lancet, Dec. 31, 1898, p. 1816. - 5Q. T. Brown Darling, Brit. Med. Jour., June 2, 1900, p. 1340.